Individual
BRADLEY DEAN GAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
98 LIBERTY LN, MINERAL WELLS, WV 26150-1605
(304) 482-2959
Mailing address
98 LIBERTY LN, MINERAL WELLS, WV 26150-1605
(304) 482-2959
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
859
WV
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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